Association of Neurocognitive and Physical Function With Gait Speed in Midlife | Dementia and Cognitive Impairment | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Putting Humpty-Dumpty Together
    Thomas Caffrey, Ph.D., Clinical Psychology | Private practice, Forensic Psychology
    This fascinating study goes a long way to mend our continued tendency to bifurcate the mental and physical in the person. As a lifelong "speed-walker," or, now, "power-walker," I was consoled by the finding that fast walking tends to reflect good CNS health and less overall cognitive decline, as well as good physical condition. It was also consoling, from a philosophical point of view, to see hard evidence for the strong link between the apparently "merely physical" gait speed and the cognitive features cited.
    Original Investigation
    October 11, 2019

    Association of Neurocognitive and Physical Function With Gait Speed in Midlife

    Author Affiliations
    • 1Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
    • 2Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
    • 3Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
    • 4Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
    • 5Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
    • 6Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
    • 7Department of Oral Sciences, University of Otago, Dunedin, New Zealand
    • 8Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina
    • 9Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    • 10Department of Medicine, Duke University, Durham, North Carolina
    • 11Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
    • 12Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina
    • 13Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
    JAMA Netw Open. 2019;2(10):e1913123. doi:10.1001/jamanetworkopen.2019.13123
    Key Points español 中文 (chinese)

    Question  Is gait speed measured at age 45 years associated with accelerated biological aging, neurocognitive function, and cognitive decline?

    Findings  In this 5-decade cohort study of 904 participants in New Zealand, physical and biological indicators of accelerated aging, including compromised brain integrity (eg, reduced brain volume and cortical thickness), were associated with slow gait measured at age 45 years. Lifelong compromised brain health—including poor neurocognitive functioning as early as age 3 years and childhood-to-adulthood decline in cognitive functioning—was associated with slower gait at midlife.

    Meaning  Gait speed at midlife may be a summary index of lifelong aging with possible origins in childhood central nervous system deficits.


    Importance  Gait speed is a well-known indicator of risk of functional decline and mortality in older adults, but little is known about the factors associated with gait speed earlier in life.

    Objectives  To test the hypothesis that slow gait speed reflects accelerated biological aging at midlife, as well as poor neurocognitive functioning in childhood and cognitive decline from childhood to midlife.

    Design, Setting, and Participants  This cohort study uses data from the Dunedin Multidisciplinary Health and Development Study, a population-based study of a representative 1972 to 1973 birth cohort in New Zealand that observed participants to age 45 years (until April 2019). Data analysis was performed from April to June 2019.

    Exposures  Childhood neurocognitive functions and accelerated aging, brain structure, and concurrent physical and cognitive functions in adulthood.

    Main Outcomes and Measures  Gait speed at age 45 years, measured under 3 walking conditions: usual, dual task, and maximum gait speeds.

    Results  Of the 1037 original participants (91% of eligible births; 535 [51.6%] male), 997 were alive at age 45 years, of whom 904 (90.7%) had gait speed measured (455 [50.3%] male; 93% white). The mean (SD) gait speeds were 1.30 (0.17) m/s for usual gait, 1.16 (0.23) m/s for dual task gait, and 1.99 (0.29) m/s for maximum gait. Adults with more physical limitations (standardized regression coefficient [β], −0.27; 95% CI, −0.34 to −0.21; P < .001), poorer physical functions (ie, weak grip strength [β, 0.36; 95% CI, 0.25 to 0.46], poor balance [β, 0.28; 95% CI, 0.21 to 0.34], poor visual-motor coordination [β, 0.24; 95% CI, 0.17 to 0.30], and poor performance on the chair-stand [β, 0.34; 95% CI, 0.27 to 0.40] or 2-minute step tests [β, 0.33; 95% CI, 0.27 to 0.39]; all P < .001), accelerated biological aging across multiple organ systems (β, −0.33; 95% CI, −0.40 to −0.27; P < .001), older facial appearance (β, −0.25; 95% CI, −0.31 to −0.18; P < .001), smaller brain volume (β, 0.15; 95% CI, 0.06 to 0.23; P < .001), more cortical thinning (β, 0.09; 95% CI, 0.02 to 0.16; P = .01), smaller cortical surface area (β, 0.13; 95% CI, 0.04 to 0.21; P = .003), and more white matter hyperintensities (β, −0.09; 95% CI, −0.15 to −0.02; P = .01) had slower gait speed. Participants with lower IQ in midlife (β, 0.38; 95% CI, 0.32 to 0.44; P < .001) and participants who exhibited cognitive decline from childhood to adulthood (β, 0.10; 95% CI, 0.04 to 0.17; P < .001) had slower gait at age 45 years. Those with poor neurocognitive functioning as early as age 3 years had slower gait in midlife (β, 0.26; 95% CI, 0.20 to 0.32; P < .001).

    Conclusions and Relevance  Adults’ gait speed is associated with more than geriatric functional status; it is also associated with midlife aging and lifelong brain health.